Topic: Woo in Physiotherapy

[quokka]

After going over the handlebars of my motorbike 2 weeks ago and landing on my right shoulder I managed to stretch and do some damage to the ligaments of my AC joint. The orthopaedic surgeon has outlined how things will play out but is waiting on some more x-rays to make a decision on surgery. In the meantime I’m seeing a physiotherapist mostly to help out with rehabilitation and working out the limitations of what I can and can’t do.





The physio was quite good at telling me exactly what was going on, but I get the feeling that most of my time and money is being wasted. A lot of talk and action was on loosening muscle knots around and under my shoulder to influence the nerves and relieve pain in my chest from what are probably strained muscles or broken ribs. I can honestly say that there was some temporary relief, but probably because the pain of getting knots out distracted me from the pain in my chest.
I have always held physios in pretty high regard and am assuming they can help me with the correct exercises to get my shoulder back, but now having actually gone to one I starting to get the impression that they might be a bit infused with woo.

Now I have the following questions,
Is there any science in getting knots out of muscles?
Can this relieve pain in other areas of the body via 'nerve pathways'?
Are physiotherapists tied up in a lot of woo?

[lonely moa]

I think knots in muscle tissue are real.  Physios and massage therapists independently find the same ones in my body.

Physios (all brits here in the village) here routinely do accupuncture, woo or not, its part of their programme... I just let them go ahead because in the end, I get a lot of positive therapy from them.   Lately, I have been recovering from surgery for a much worse shoulder injury than yours and have really good treatment from my physio.  She followed the surgeon's schedule and didn't let me do any active strenghtening for 12 weeks.  I am away now and can now reach the chinnup par in the gym, do a lightweight set of barbell exercises, take the outdoor ed kis tramping and RIDE MY BIKE.

[quokka]

Your tolerance levels for dubious treatments must be higher than me.  I was in there today and when the physio started up on the need to remove the knots in point 'A' to relieve the pain in point 'B' I was starting to think, that $145 I'm paying for this visit could be better spent on top shelf scotch which I reckon would be much more effective. Honestly, if this was all free it wouldn't bother me, I just feel like I'm being ripped off. Even if some of what is being done is effective, I think it is analogous to paying a mechanic to replace the whole engine in your car to fix a leaky radiator.

[hfleming]

In the States, physiotherapists shouldn't be doing acupuncture, craniosacral therapy, or any other SCAM. The field is science based and has reputable journals (unlike, say, chiropractic). Occasionally, you will find a therapist that practices SCAM, but that's because they suck at their job and/or picked up some continuing education credits from SCAM practitioners. Your condition should be well within their scope. Knots are real, inflammation is real, but I'm not sure what you are asking about "nerve pathways". I have no idea what the field is like in every country.

[khendar]

There's a fine line between accupuncture (what woo-meisters do) and dry needling (which physios sometimes do). I think the difference is that dry needling usually involves putting a needle into the site of a knot, rather than along magical median lines. There's some evidence that it does work, but there's still some doubt about it. A deep tissue massage is probably just as effective at relieving somatic dysfunction.

 http://en.wikipedia.org/wiki/Myofascial_release
http://en.wikipedia.org/wiki/Trigger_point

[hfleming]

I've never heard of a PT doing "dry needling". I'm pretty sure they can't get reimbursed for that in a hospital setting (in America). The PT's that work in chiropractic clinics are different animals entirely. Gods know what they do.

I have heard of PT's doing myofacial release therapy. It's up there with craniosacral therapy (in America) as something that separates the good PT's (who stick to their literature) from bad PT's (who learn random SCAM from their continuing education credits). This is the significant problem with PT in the U.S.: they can pick up any conceivable garbage, no matter how stupid, in their continuing education. The ones fresh out of school are usually good, and then some fraction of those drift off into the world of nonsense.

[lonely moa]

Your tolerance levels for dubious treatments must be higher than me.  I was in there today and when the physio started up on the need to remove the knots in point 'A' to relieve the pain in point 'B' I was starting to think, that $145 I'm paying for this visit could be better spent on top shelf scotch which I reckon would be much more effective. Honestly, if this was all free it wouldn't bother me, I just feel like I'm being ripped off. Even if some of what is being done is effective, I think it is analogous to paying a mechanic to replace the whole engine in your car to fix a leaky radiator.

I guess I am paying $30 for a visit (part charge and up to an hour in the rooms) and getting real value for my time and money.  The manipulation, exercise advice and maybe the accupuncture as well have turned my life  around since shoulder surgery.  Just finished another tramp with the outdoor ed hs kids today. A month ago I couldn't put on a t shirt.  I love physios.

[babelchick]

Hey, I have had terrific results with physio's, but like in all fields, not all practitioners are the same. On the topic of shoulders, I have a congenital depression of the cervical collar cause thoracic outlet (nerve and circulation) problems as well as some TMJ and face nerve problems resulting from a good face plant into the concrete as a kid. In both cases I've had some terrific (if initially painful) experiences from working with physio's. But in both cases I have spent  time with a specialist physio working with a treating surgeon. In terms of effective long term treatment for the chronic and painful conditions I was lumped with I can not rate these people highly enough. On the other hand, I've seen random physio's at times and left feeling robbed and up assisted.

[Plastique]

Forget getting knots out of muscle—what the hell is a "knot" in muscle?

[lonely moa]

My physio and massuse call them trigger points.  Painfully effective.

[khendar]

Forget getting knots out of muscle—what the hell is a "knot" in muscle?

From my link above: http://en.wikipedia.org/wiki/Trigger_point

• Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.
• The painful point can be felt as a nodule or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point.
• Palpation of the trigger point reproduces the patient's complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point.
• The pain cannot be explained by findings on neurological examination.

[Plastique]

Interesting. But "a discreet, irritable point" doesn't tell us much really. Wonder what the cause is.

[lonely moa]

Interesting. But "a discreet, irritable point" doesn't tell us much really. Wonder what the cause is.

Depends if it is your "discreet, irritable point".  A good practitioner can alleviate the distress associated with it, in my limited experience.  I think those points are generated by poor posture and inappropriate overuse, maong other things (there must be other things).

[goodthink]

When I first hurt my back I was a bit put off by the use of acupuncture. But I became desperate enough to try it.


I went to an osteopath recommend by a lawyer who said she fixed him up. I just wanted to be able to walk to the bathroom without throwing up at that point. I think the whole industry is loaded with quackery for a few reasons, the intractable nature of the pain, the pain resolving on it's own and the desperation people experiencing chronic pain endure.


Gabapentin worked far better than physio.

[hfleming]

When I first hurt my back I was a bit put off by the use of acupuncture. But I became desperate enough to try it.


I went to an osteopath recommend by a lawyer who said she fixed him up. I just wanted to be able to walk to the bathroom without throwing up at that point. I think the whole industry is loaded with quackery for a few reasons, the intractable nature of the pain, the pain resolving on it's own and the desperation people experiencing chronic pain endure.


Gabapentin worked far better than physio.

Not sure if you are familiar with Quackcast, but there have been episodes covering chiropractic and osteopathic versus physical therapy (medicine). The research appears to indicate that chiropractic and osteopathic work about as well for neck and back pain, but are more dangerous because they involve rapid manipulations.